Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes
Authors' conclusion
Hypercortisolism was associated with hyperglycemia in approximately one-quarter of individuals with inadequately controlled type 2 diabetes despite multiple medications.
Study context
- Population
- Adults with T2D and HbA1c 7.5%-11.5% (58–102 mmol/mol) on ≥2 glucose-lowering medications, with or without micro-/macrovascular complications or taking multiple BP-lowering medications; common causes of false-positive DSTs excluded
- Participants
- 1,057 adults
- Outcome
- Prevalence of hypercortisolism, defined as post-DST (1-mg dexamethasone suppression test) cortisol >1.8 μg/dL (50 nmol/L)
Main finding
As reported in the abstract
Hypercortisolism (unsuppressed post-DST cortisol)
Prevalence of hypercortisolism
23.8%
252 of 1,057; 95% CI 21.3, 26.5
Observational data: associations, not effects.
Further findings
Hypercortisolism prevalence in subgroups
- Participants with cardiac disorders
- 33.3%
- Taking ≥3 BP-lowering medications
- 36.6%
Adrenal imaging abnormalities among participants with hypercortisolism
- Adrenal imaging abnormalities
- 34.7%
Characteristics associated with higher hypercortisolism prevalence (multiple logistic regression, OR; all P < 0.03)
- SGLT2i use (OR)
- 1.558
- Maximum-dose GLP-1 RA use (OR)
- 1.544
- Tirzepatide use (OR)
- 1.981
- Higher number of BP-lowering medications (OR)
- 1.390
- Older age (OR)
- 1.316
- BMI <30 kg/m² (OR)
- 1.639
- Non-Latino/Hispanic ethnicity (OR)
- 3.718
- Fibrate use (OR)
- 2.676
- Analgesic use (OR)
- 1.457
- All P < 0.03
Original publication
Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes. Diabetes Care. Published 18 April 2025. doi:10.
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